稳定性冠心病的循证治疗及预后改善  

Evidence-based Treatment for a Patient with Stable Coronary Heart Disease

作　　者：王宾友[1] 何萍[1] 董碧蓉[1] 

机构地区：[1]四川大学华西医院老年科,成都610041

出　　处：《中国循证医学杂志》2006年第1期63-68,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的为一例因“反复活动后心悸1＋月”的早发绝经女性冠心病稳定期患者制定治疗方案。，方法根据患者临床状况，提出“如何改善冠心病患者稳定期预后”等7个临床问题，检索Cochrane图书馆（2005年第2期）、Evidence-based medicine reviews（EMBR）（1991—2005）、MEDLINE（1991～2005）数据库，纳入冠心病治疗的系统评价、Meta分析和随机对照试验，根据所获证据给患者制定治疗方案。结果共纳入34个研究。有证据昆示：三类药物（阿司匹林、β-阻滞剂和他汀类降脂药），运动与饮食疗法，75mg／d阿司匹林二级预防，控制LDL于2．6mmol/L以下，可提高疗效，改善患者预后；ACEI类药物应视患者情况选择使用；但冠状动脉造影及介入治疗对最近3月无冠脉事件发作的患者获益不明显，且成本一效益更低；激素替代治疗甚至有增加血栓性疾病的风险。结合患者情况，应用证据治疗2月后，患者体莺下降、未发生心绞痛症状且血脂达到理想水平。结论以高质量证据、结合患者情况制定治疗方案，能明显提高稳定性冠心病患者的近期疗效，但远期预后尚需更长时间的随访观察。Objective To make an individualized treatment plan for a premature menopause female who was diagnosed as stable coronary heart disease with the symptom of frequent palpitation after physical activity for over 1 month.. Methods Seven clinical problems were put forward after assessing the patient＇s health state. We searched The Cochrane Library （ Issue 2, 2005 ） , evidence-based medicine reviews （EMBtk） （ 1991 - 2005 ） , and MEDLINE （ 1991 - 2005 ） databases. Systematic review, meta-analysis and randomized controlled trials about the treatment of coronary heart disease were included. The treatment plan was developed accordingly. Results After evaluating, thirty-four studies were ehglble. The evidence indicated that three kind of drugs （aspirin, h-blockers and statins）, exercise and dietary therapy, and 75mg/d aspirin for secondary prevention, could improve the therapy effect and the prognosis by controlling LDL below 2.6 mmol/L; ACEIs should be used depending on the patient＇s condition; coronary arteriography and interventional strategy helped little for patients without coronary artery events in recent 3 months, and their cost-effectiveness was lower; hormone replacement therapy even increased the risk of thrombosis. The individualized treatment plan was developed based on the available evidence. After 2 months, the patient＇s weight declined, the symptom of angina disappeared and the lipidemia reduced to aimed level. Conclusions The individualized treatment plan based on the high quality evidence and patient＇s condition is optimal for the short-term treatment of stable coronary heart disease. However, the long-term prognostic benefits need to be confirmed by continuing follow-up.

关 键 词：稳定性冠心病 循证治疗 

分 类 号：R541.4[医药卫生—心血管疾病]